I read advice that women on HRT should lay off the phytoestrogens available in plants like soy, flax, red clover, dang gui, etc., because their effect is much weaker than pharmeceutical estrogen. The weaker phyto gets on the receptors and blocks the real stuff, if I understand correctly.
If so, I need some Straight Dope because if you notice the foods and nutritional made specially for women these days, they’re loaded with soy isoflavones and flaxseed.
I doubt the small amount of phytoestrogen available from munching a Luna Bar will make any difference in a woman’s body. But I’ve been vegan for years and living on a diet that is very rich in soy, my main source of protein. I was also ingesting daily flaxseed and flax oil for the omega fatty acids for their cardiac benefits. That these nutrients added some estrogen seemed an added benefit. I was also using dang gui specifically for its estrogen, but if it produced any result it’s too slight to tell for sure. There is controversy between herbalists who insist phyto works and others who insist it’s worthless. Based on my experience, I would say if it works at all, its effect is minimal.
But now that I’m on HRT, I’ve cut out the herbs and flaxseed. I need to know the science on how much does phytoestrogen block HRT, and whether I need to change my diet away from so much soy.
A similar question is about progesterones, which are needed for breast development. Some women use a topical cream made from wild yam, whose progesterone is supposed to be chemically similar to that in humans. Would wild yam block pharmaceutical progesterone in a similar way?
Standard disclaimer: Internet advice is worth what you pay for it, I am not your doctor yada yada, advice on hormone replacement has changed considerably since the HERS study and will change again, and the specific questions you ask are not well studied at this pont.
I personally think the benefits of dietary phtoestrogens are probably exaggerated. I see no reason to modify the amount of soy you consume since I think any competitive effect would be minor and that having such a good source of protein is a more important effect than the weak estrogen effects. However, research seems to be too premature to answer your question completely – and some of the results seem contradictory (e.g. breast cancer and phtoestrogens).
Hormone replacement therapy can be used for menopause, but is that what we’re talking about here? I didn’t see that specifically mentioned. Others use hormone replacement therapy for other health reasons and the different indications and different populations would mean different risks or effectiveness. The dietary stuff can’t be relied on, anyway, since there is no control in purity, strength or dose.
Good point, Jill, in my case it’s being put to transsexual purposes. I don’t know what difference it would make, but I’m on a combination of Estradiol for the estrogen and Spironolactone for the testosterone blocker. Over a year of dang gui, flax, etc. seemed to bring about a very small amount of breast growth, and the sensitivity went up last month, weeks before I got on HRT. It indicated that something was happening there. My friend had slipped me a couple of Estradiol sublingual pills last year, which doesn’t seem nearly enough to have such an effect. But as soon as I injected 0.5 cc of Estradiol last week (a modest dose), I had observable breast growth within 24 hours. I seem to respond very well. I can’t tell how much effect those two pills a few months apart had, as opposed to a year of herbs, but either way it’s so little as to be insignificant. I could never grow boobs on herbs alone. Whatever effect they may have had is so small it can’t be distinguished from background noise.
Similarly, I wonder if progesterone derived from wild yam would interfere with pharmeceutical progesterone.
Thanks for the wealth of information, Dr. Paprika! This is what I call Straight Dope!
Again, “phytoestrogen” is a vague term encomnpassing many differnet chemicals that act on receptors differently. The effect of combining most of them with HRT is unknown and, in my unolearned opinion, likely exceedingly modest. I would not change your soy diet, and I doubt that the diosgenin in yam would interfere a great deal with progesterone unless you are eating buckets of yam. Many of the claims for phytoestrogens come from alternative medicine gossip. Many doctors I know are very accepting of herbal medicines and alternative therapies, espcially those that have been properly studied – gossip is not evidence, observational trials are a weak form of evidence (for patent medicines or any other therapy as well) and a person selling you yam cream has a vested interested in saying it does more than squat – q.v. quackwatch http://www.quackwatch.org/01QuackeryRelatedTopics/wildyam.html
Soy is an excellent source of protein for vegans and this is not a trivial thing. Dietary nutrients in general are much overwhelmed by taking much higher exogenous doses, which would still hold even if the chemicals were in direct competition at receptor sites which is a worst case scenario and probably not what occurs for many of these chemicals. I am not an expert on this however, and no one knows the full truth at this point. Percocet addicts feel far more pain to everyday things than non-addicts who still make the natural chemicals the body uses for minor pains… and I think the same analogy applies to your query. I hope you can trust your doctor to discuss things like this with her, or him, rather than get estradiol surreptitiously without further information.
Okay, hopefully someone can fight some ignorance, but isn’t this effect just a side effect of the drug? It doesn’t seem like using a diuretic is the best idea for what Johanna wants (although a side effect is gynaecomastia), as it does cause hyperkalaemia.
A doctor I knew who had a number of transsexual patients at the Indian Hospital used to give them some kind of medication that was indicated for prostate cancer, that supposedly blocked testosterone. Or something.
there are a number of good resources out there about research that has been done on the effects of hormones on transgendered persons. http://www.inhousepharmacy.com/transgender/transgender.html
It appears that there are several health risks that M->F transsexuals have to watch when they go on estrogen and it’s really best to get these prescriptions from, and to be monitored by, an endocrinologist. I read about diabetes, blood clots and liver problems, to name a few. From what I saw in a quick search, Spironolactone is a typical drug to use for antiandrogenic purposes.
As JillGat notes, spiro is one of the most common anti-androgens used, if not the most common. I’ve heard good things about androcur, but I don’t believe it is legally available here in the US yet. While it probably would be best for transsexuals for scientists to develop a anti-androgen just for them, there isn’t the money in that line of research so they are forced to use alternative methods.
I don’t know how much scientific fact is behind this, but apparently you want to avoid potassium-rich foods while on Spiro. A lot of the girls on spiro that I know told me that they avoid bananas for this reason. Of course, you should talk to your doctor about any dietary concerns.
And I do hope that you are seeing a professional and only taking the drugs that he is prescribing at the doses at which he is prescribing them to you. I know that they may feel too small or not doing enough at first, but it is important that you don’t try to self med. Be safe!
Spirolactone is a K+ Sparing diuretic. This means that it “spares”/keeps potassium instead of you peeing it out. This also means it can easily lead to hyperkalaemia (too much potassium) quite easily, which is why I was so surprised it was being used for this purpose.
Spironolactone, when I learn to spell.
Remember, it is primarily a diuretic, so keep up the fluids. Avoid all potassium rich foods with this drug. This is only a weak diuretic, so hopefully its effects won’t be too bad. But if you start getting hypotensive, see your doctor.
I second kimera’s advice at self medicating. Don’t do it with this drug. I had to do an experiment last week where I took a mild diuretic. I peed a ridiculous amount, then ended up puking everywhere afterwards. I was the only one.
My HRT has been under a physician’s supervision from the start. I have not noticed any diuretic effect from the spiro, but then I’m on a low dose to start, 1mg per day. I know from diuretic, I’ve used dandelion root and there’s no mistaking how well that stuff works. Speaking of which, if you own a juicer, do not drink parsley juice before bed. You won’t get much rest. I hadn’t known about the potassium, thanks for the information, kimera, and thanks for the link, Jill.
Well a good rule of thumb would be: If you’re not experiencing the diuretic effect, it isn’t working yet. It only binds to the androgen receptor at high doses. I think you’re on greater than 1mg/day; it’s only manufactured in 25, 50 and 100mg tablets. Check out the rxlist on it, which everyone should do when they get a new drug!
However, I cannot believe your physician did not tell you about the hyperkalaemia (high potassium), it’s spironolactone’s main effect, and is quite dangerous. I hope they were planning on telling you when they upped your dose. The Wiki on it holds some valuable information.
Foods high in Potassium include various things; figs, prunes, dates, raisins, apricots, sweet potato, white potato, orange juice, grapefruit juice…